GA68-PSMA results - its on the lungs. Questions

[MichaelDD]

Below is my last weeks post of my history. I had my scan last Friday 10/12/18. Tuesday morning my oncologist's office called and said that the doctor wants to up my appointment to this coming Monday 10/22. Later Tuesday he calls. Said that their were 9 nodules on my lungs all less then a centimeter that lit up with the GA scan. What struck him was that this was the only sight of metastasis. No lymph nodes. No bone. Straight to the lungs. He was straight forward with me in that he has only seen this once before me. T-Allen said a while back it was hiding and he said the same. I was dumbfounded with this and asked only about lymph nodes . He again said no involvement. He would be researching and we will discuss at my appointment. I don't know what questions I should ask? Drugs and chemo are they the same ? I'm at a loss and any direction would help. I'm sure I will be a Googling fool until I seem him... thank you

LAST WEEK:

I was a G8 and had DaVinci in 2016. After RP first PSA was .024 then waited next in October .042 Mid Oct '16 38 sessions radiation. Came out after .080

Since then doubling every 3.2 to 4.5. months. Overall average 4.2 months. This month PSA is 1.7 Without "anything " my Oncologist has yet to pull the trigger on ADT/chemo.

3 scans have shown nothing. Last Friday I had the GA68-PSMA at UCSF. Waiting this week for results.

He too discussed 10. The change for me is now what will Friday show? His thoughts were if that warrants action then of course we start. Now that I'm in"single digits" and if I have a doubling in 3 months then that too is a big consideration.

Feel confident with him. He is close to the researchers at UCSF. His college roommate is there and is part of the team involved with much of the prostate dealings. He consults with them regularly. Feel confident with him (or of course I wouldn't be his patient!)

[Hidden]

I'm not a doctor, but I would think that ADT + chemo would be the best option. Since it's only metastasized to the lungs, I would want to know if the cancer has any "neuroendocrine differentiation". Cancer with neuroendocrine or "small cell" characteristics often goes to the lungs and/or major organs. That type of Prostate Cancer doesn't have an androgen receptor, therefore it doesn't respond to ADT and doesn't make PSA so you can have a fairly low PSA with it. Chromagranin A is a marker for this kind of cancer and can be checked by a blood test. If that's what you have, the treatments might change depending on the percentage. It's something you could discuss with your doctor.

[Tall_Allen]

Early chemo is particularly effective when there are early visceral mets. i think you would do fine with Zytiga too. But if you have to do one first (and Schwah is doing both together), chemo usually takes 18 weeks. So you could move onto Zytiga after 18 weeks. But if you start with Zytiga, it can be two years or more before you could move on to chemo.

[Grumpyswife]

There are others on here with lung mets including my husband. He had two lesions and a lymph node removed in a wedge resection and after 14 months or so two more were seen. We have tried to find someone to do radiation to the lesions but so far no luck due to their location. One RO said he felt a systemic treatment such as chemo, Xtandi or Zytiga would be best added to ADT.

Please keep posting about your treatment decisions.

Mary

[MichaelDD in reply to Grumpyswife]

Mary..I will. Somewhat scared but have to keep walking forward. Appreciative of you and the support you bring here. More importantly to and for your husband. You're an angel. Stay strong!

[Chask]

Allen, I have seen you make this comment before, that you need to wait 2 years to move onto Chemo after having Zytiga. Why is that?

[sgrama in reply to Chask]

My husband had 7 treatments of chemo and then was started on zytiga like 4 months later because PSA was rising rapidly. Now this year he just finished another 6 cabazitaxel chemo treatments on Sept. 20th because psa more than doubled while on it so he was just started on enzalutamide (Xtandi).

[whatsinaname in reply to sgrama]

So from Docetaxel to Zytiga to Cabazitaxel to Xtandi all well within a year ? Does your uro-oncologist have any further plans ? So sorry to hear about your husband.

[sgrama in reply to whatsinaname]

He started docetaxel Dec. 13th 2016 and finished it May 2017 and then in Aug. 2017 was started on Zytiga and ended it in Feb. 2018 and then he had 3 Provenge treatments from March and ended in April but by June PSA was 657 so he was started on Cabazitaxel June 7th and just finished treatment 6 on Sept. 20th and PSA is now 1350. He just started this week on Xtandi and then starting Nov 4th he’ll be starting Radium-223 (Xofigo) along with the Xtandi. That’s the plan for now and I hope and pray something works. He’s almost 77 and was diagnosed at age 64. It will be 2 years next month since scans showed it in his bones.

[whatsinaname in reply to sgrama]

I know its no satisfaction to you but your husband has now survived 13 years since diagnosis. For me, its been barely 8 months and I am already "castrate resistant" with multiple mets all over the body at just age 62.

That is what I call LUCK. Someone asked me why don't I pray to God. And, when I become "God-resistant", what then ??

All the very best to your husband. Try and enjoy life. Cheers !!

[whatsinaname in reply to Chask]

Tall_Allen,

I too would be very interested in your reply to Chask's question. Please answer if you get the time. Thank you.

My uro-oncologist has endorsed your suggestion of Chemo (Docetaxel) first (for me). However, he says that after 18 weeks/30 weeks of Chemo, he would like to put me on Enzalutamide not Abiraterone. Your views ??

Thanks very much indeed.

[monte1111]

Enzalutamide or Abiraterone may give you a much longer run before psa/radiographic progression. I did 8 cycles Taxotere= 24 weeks, which brought psa to 1.7 and going down. Now on Xtandi and after 14 months, about 56 weeks psa is 0.2. When psa starts going up I could try chemo again (I think). Was told my next stop will be Provenge. We shall see. You can only do so many cycles of chemo, but, if you are lucky, enz or abi may keep you going for quite a while. Maybe 2 years or more. So bring out the heavy chemo gun and hope it gives the other treatments a chance. Am sure others, including Tall_Allen will reply and make more sense of my post.

[whatsinaname in reply to monte1111]

Thank you very much, monte1111.

I think I understood what you said, thank you very much indeed.

Cheers !!

[whatsinaname in reply to monte1111]

Thank you, monte1111.

It just struck me that I possibly have less than 2 years to live.

About a year back, before I was diagnosed, I had thought 75 would be par for the course.

I am 62 now.

I'll take whatever I get, no complaints.

Cheers, monte1111, thank you very much for everything.

[monte1111 in reply to whatsinaname]

Hi whatsinaname. I had 8 cycles. Was supposed to be 6. You're doing number 4 of 6 now I think. Your Psa is at least level and not going up. So in just a month and a half or two months you should probably start Xtandi or Zytiga? Time to relax and enjoy. Stressing will get you nothing. I'm at the 2 year period and feeling strong. Do something for someone. Or something for yourself. You deserve it. Just bought a 43" 4k tv to use as a pc monitor. Swore i'd get one when i could get it for less than $200. Best Buy had one for $199.99 I'll probably need to get some sunglasses now. Ray-Ban.

[whatsinaname in reply to monte1111]

Thank you, monte1111, for that sound advice.

I am going on vacation from 21st Jan to 29th Jan. The idea is to relax and enjoy.

I will be off the Internet completely for that period.

Thanks again, monte1111, much obliged.

[j-o-h-n]

From my previous post above. Sorry but I might be whistling in the dark regarding your lung situation, but as I stated below "Maybe this will help".

"To MichaelDD, Maybe this will help. I've posted a few times that I have Melanoma Lung Cancer stage IV (and Pca) . I am currently being treated at MSKcc in NY City with Keytruda and it's working. I've asked my Melanoma Oncologist and my Prostate Oncologist if it helps with my Pca. They both replied that it had very little effect but maybe it helps the other way around, Pca and then lung cancer (but not melanoma lung cancer) if you follow me. Give it a try? (Keyturda = $30K a treatment).

Good Luck and Good Health.

j-o-h-n Sunday 10/21/2018 7:16 PM EDT

[Unusualmint45]

Hi Michael --my 1/18/19 CT scan was compared to 2/21/18.

Findings:

Neck base No lymphadenopathy

Mediastinum and lymph nodes- No lymphadenopathy

Lungs: Significant interval decrease in size of multiple bilateral

pulmonary nodules. For example, a peripheral nodule in left lower lobe currently measures 3mm and previously measured 7mm. No new nodules.

Upper abdomen: unremarkable

Soft tissue/musculoskeletal: no acute osseous abnormality

Impression- Significant interval decrease in size of multiple bilateral

Nodules, consistent with interval treatment response. No new nodules.

I'm having no side effects from lupron and zytiga to speak of.

Losing muscle and some weight so trying to increasing calories and weight has stabilized. Working out 3+ times a week running 2-3 miles. Weight training to keep what muscle I have.

Hope you are doing well. Keep in touch.

Frank

Let know if you recieve this reply.

I've been on lupron/Zytiga for 9mo.